Format

Send to

Choose Destination
Chest. 2017 Jun;151(6):1272-1278. doi: 10.1016/j.chest.2017.03.005. Epub 2017 Mar 11.

The Potential Role of Aspiration in the Asthmatic Airway.

Author information

1
Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland.
2
The Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, England.
3
The Department of Radiology, Cork University Hospital, Cork, Ireland.
4
The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland.
5
The Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
6
The HRB Clinical Research Facility, University College Cork, Cork, Ireland.
7
The Department of Radiology, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland.
8
Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland. Electronic address: desmond.murphy@hse.ie.

Abstract

BACKGROUND:

Many people with asthma remain suboptimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastroesophageal reflux. We aimed to investigate whether aspiration occurs in patients with asthma and, if so, does it correlate with asthma control?

METHODS:

Patients had Asthma Control Questionnaire 7 (ACQ-7), fractional exhaled nitric oxide, and spirometry performed to characterize their level of asthma control. Barium swallow with provocation was performed to assess for predisposition to aspiration. Patients underwent bronchoscopic investigation, with BAL pepsin measured as a marker of aspiration.

RESULTS:

Seventy-eight patients stratified by disease severity (Global Initiative for Asthma) into mild (35.8%), moderate (21.7%) and severe (42.3%) were studied. Pepsin was detectable in BAL in 46/78 (58.9%). There were no differences between pepsin levels in patients with different disease severity. Furthermore, no significant associations were seen between pepsin level and measures of asthma control, FEV1, ACQ-7 or exacerbation frequency. Similarly no associations were found with adjustments for smoking history, BMI, proton pump inhibitor use, eosinophil count or IgE. When stratified into eosinophilic or neutrophilic asthmatic populations on the basis of BAL, there was no relationship to detected pepsin concentrations. A positive barium swallow (seen in 33/60 patients) did not correlate with BAL pepsin level and we found no significant association between barium swallow result and ACQ-7, Global Initiative for Asthma, exacerbation frequency or FEV1 using either univariate or multivariate analyses.

CONCLUSIONS:

This study suggests that the importance of aspiration on current asthma symptom control and exacerbation rate may be overstated. However, this study did not address the role of aspiration and future risk of exacerbation.

KEYWORDS:

aspiration; asthma; inflammation; reflux

PMID:
28300572
DOI:
10.1016/j.chest.2017.03.005
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center